Apparatus and method for cutting tissue

ABSTRACT

A cutting instrument comprising:
         an outer tube comprising a distal end and a proximal end;   an inner tube rotatably disposed within said outer tube, said inner tube comprising a distal end, a proximal end and a region intermediate said distal end and said proximal end, said region comprising a plurality of slits formed in said inner tube so as to render said region of said inner tube flexible; and   a bellows disposed adjacent to said plurality of slits so as to render said region of said inner tube fluid-tight.

FIELD OF THE INVENTION

This invention relates to surgical apparatus and methods in general, andmore particularly to surgical apparatus and methods for cutting tissue.

BACKGROUND OF THE INVENTION

In many situations, tissue may need to be accessed at a remote surgicalsite, excised from the adjacent anatomy and then the excised tissueremoved from the remote surgical site. By way of example but notlimitation, during arthroscopic surgery, endoscopic surgery, ENTsurgery, etc., relatively small visualization devices (e.g., “scopes”)and relatively small surgical tools (e.g., graspers, cutters,cauterizers, etc.) may be introduced into a restricted portion of thehuman body (e.g., the interior of a joint, the interior of the abdomen,the interior of a nasal passage, etc.) and then used at that locationfor a specific surgical procedure (e.g., to trim meniscal cartilage in ajoint, to excise a tissue mass in the abdomen, to excise a tissue massin a nasal passage, etc.).

In many such surgeries, fluid may be introduced into the surgical site(and thereafter removed from the surgical site) so as to distend theanatomy for better access and/or visualization (e.g., so as to distendthe knee joint for better access and/or visualization), and/or toimprove visibility (e.g., so as to flush away blood), and/or to removedebris (e.g., so as to remove severed tissue by suction.)

One of the surgical tools frequently employed in such surgeries is theso-called “powered shaver”. Powered shavers typically comprise an outertube having a window, and an inner tube rotatably disposed within theouter tube and having an opening, wherein rotation of the inner tubewithin the outer tube causes the opening of the inner tube torepetitively sweep across the window of the outer tube, whereby to shearoff tissue extending into the window of the outer tube and the openingof the inner tube. Suction is typically applied to the interior of theinner tube so as to remove the tissue sheared off by the powered shaver.

Ideally, in addition to providing the aforementioned cutting action, thepowered shaver is also able to provide either irrigation or suction tothe remote surgical site, as desired by the surgeon, or tosimultaneously provide both irrigation and suction to the remotesurgical site.

In one construction, irrigation fluid is supplied to the gap between theinterior of the outer tube and the exterior of the inner tube so thatthe irrigation fluid can be used to distend the anatomy and/or flushaway blood and/or debris, and the irrigation fluid (and/or blood and/ordebris) is removed from the surgical site by suction which is applied tothe interior of the inner tube. In this way, the powered shaver is ableto provide irrigation, cutting and suction in a single device.

Unfortunately, in many situations it may be desirable to form thepowered shaver with a curved (i.e., non-linear) configuration. In thissituation, the inner tube must be flexible in order to allow the innertube to rotate about a curved axis (i.e., the curved axis of the outertube), but must also be able to transmit torque along its length so asto enable cutting.

One approach for forming a flexible, torque-transmitting inner tube forthe powered shaver is to form the inner tube with a plurality of slitsextending through the side wall of the inner tube—these slits enable theinner tube to flex as it rotates about a curved axis while stillallowing torque to be transmitted along the length of the inner tube.

Unfortunately, providing slits in the inner tube of a powered shaver isproblematic where irrigation fluid is to be supplied to the surgicalsite through the gap between the interior of the outer tube and theexterior of the inner tube, and where suction is to be applied to thesurgical site through the interior of the inner tube, since the slits inthe inner tube effectively create a “short circuit” between theirrigation and suction lines, thereby undermining the irrigation andsuction functions. Therefore, it can be problematic to provide a poweredshaver which can provide irrigation, cutting and suction in a singledevice, and which has a curved (i.e., non-linear configuration).

Also, in situations where suction is to be applied to the surgical sitethrough the interior of the inner tube without supplying irrigationfluid to the surgical site through the gap between the interior of theouter tube and the exterior of the inner tube, the provision of slits inthe inner tube may compromise suction effectiveness at the surgical site(i.e., the suction force at the distal end of the inner tube is reducedsince the slits in the inner tube allow the suction source to pullthrough the wall of the inner tube from the gap between the interior ofthe outer tube and the exterior of the inner tube).

A similar problem occurs where irrigation fluid is to be applied to thesurgical site through the interior of the inner tube without applyingsuction to the gap between the interior of the outer tube and theexterior of the inner tube.

Thus it would be advantageous to provide a new powered shaver which isable to provide, either independently or simultaneously, irrigation,cutting and/or suction in a single device, and which may have a curved(i.e., non-linear) configuration. Furthermore, it would be advantageousto provide a new powered shaver which may have a curved (i.e.,non-linear) configuration, wherein the new powered shaver comprises anouter tube and an inner tube rotatably disposed within the outer tube,with the lumen of the inner tube being fluidically sealed from the gapbetween the exterior of the inner tube and the interior of the outertube.

SUMMARY OF THE INVENTION

The present invention comprises the provision and use of a novel poweredshaver which is able to provide, either independently or simultaneously,irrigation, cutting and/or suction in a single device, and which mayhave a curved (i.e., non-linear) configuration.

The present invention also comprises the provision and use of a newpowered shaver which may have a curved (i.e., non-linear) configuration,wherein the new powered shaver comprises an outer tube and an inner tuberotatably disposed within the outer tube, with the lumen of the innertube being fluidically sealed from the gap between the exterior of theinner tube and the interior of the outer tube.

In one form of the invention, there is provided a cutting instrumentcomprising:

an outer tube comprising a distal end and a proximal end;

an inner tube rotatably disposed within said outer tube, said inner tubecomprising a distal end, a proximal end and a region intermediate saiddistal end and said proximal end, said region comprising a plurality ofslits formed in said inner tube so as to render said region of saidinner tube flexible; and

a bellows disposed adjacent to said plurality of slits so as to rendersaid region of said inner tube fluid-tight.

In another form of the invention, there is provided a method for cuttingan object, said method comprising:

providing a cutting instrument comprising:

-   -   an outer tube comprising a distal end and a proximal end;    -   an inner tube rotatably disposed within said outer tube, said        inner tube comprising a distal end, a proximal end and a region        intermediate said distal end and said proximal end, said region        comprising a plurality of slits formed in said inner tube so as        to render said region of said inner tube flexible; and    -   a bellows disposed adjacent to said plurality of slits so as to        render said region of said inner tube fluid-tight; and

rotating said inner tube relative to said outer tube in order to cut theobject.

BRIEF DESCRIPTION OF THE DRAWINGS

These and other objects and features of the present invention will bemore fully disclosed or rendered obvious by the following detaileddescription of the preferred embodiments of the invention, which is tobe considered together with the accompanying drawings wherein likenumbers refer to like parts and further wherein:

FIG. 1 is a schematic view showing a novel powered shaver formed inaccordance with the present invention;

FIGS. 2 and 3 are schematic views showing the blade assembly of thepowered shaver shown in FIG. 1;

FIGS. 4, 4A and 5 are schematic views showing the outer tube of theblade assembly shown in FIGS. 1-3, with FIG. 4A being a schematic viewshowing the distal end of the outer tube of the blade assembly of FIG. 4but with the outer tube having been rotated 90 degrees about itslongitudinal axis from the position shown in FIG. 4;

FIG. 6 is a schematic view showing the inner tube subassembly of theblade assembly shown in FIGS. 1-3;

FIG. 6A is a schematic view showing the distal end of the inner tubesubassembly of FIG. 6 but with the inner tube subassembly having beenrotated 90 degrees about its longitudinal axis from the position shownin FIG. 6;

FIGS. 7, 7A and 8 are schematic views showing details of the inner tubesubassembly shown in FIGS. 1-3 and 6;

FIGS. 8A and 8B are schematic views showing alternative inner tubeswhich may be used with the inner tube subassembly shown in FIGS. 1-3 and6; and

FIGS. 9 and 10 are schematic views showing an alternative form ofbellows which may be utilized in the inner tube subassembly of thepresent invention.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

The present invention comprises the provision and use of a novel poweredshaver which is able to provide, either independently or simultaneously,irrigation, cutting and/or suction in a single device, and which mayhave a curved (i.e., non-linear) configuration.

The present invention also comprises the provision and use of a novelpowered shaver having a curved (i.e., non-linear) configuration, whereinthe new powered shaver comprises an outer tube and an inner tuberotatably disposed within the outer tube, with the lumen of the innertube being fluidically sealed from the gap between the exterior of theinner tube and the interior of the outer tube.

More particularly, and looking now at FIG. 1, there is shown a novelpowered shaver 5 formed in accordance with the present invention. Novelpowered shaver 5 generally comprises a blade assembly 10 and a handleassembly 15. As will hereinafter be discussed in further detail, bladeassembly 10 is intended to be mated to handle assembly 15 (or anotherhandle assembly) at the time of use, and detached from handle assembly15 (or another handle assembly) after use (e.g., for cleaning andsterilization, repair or replacement, etc.). Alternatively, bladeassembly 10 may be mated to handle assembly 15 (or another handleassembly) at the time of manufacture, e.g., such as in the case of aone-piece disposable system.

Blade assembly 10 is shown in greater detail in FIGS. 2-8. Bladeassembly 10 generally comprises an outer tube 20 and an inner tubesubassembly 25 rotatably disposed within outer tube 20.

Outer tube 20 is shown in greater detail in FIGS. 2-5. Outer tube 20generally comprises a distal end 35, a proximal end 40, and a lumen 45extending from distal end 35 to proximal end 40. In one preferred formthe present invention, outer tube 20 preferably comprises a distal endsurface 48.

Outer tube 20 comprises a window 50 (FIG. 4A) comprising a distal edge55, a proximal edge 60, a first side edge 65 and a second side edge 70.

In accordance with the present invention, outer tube 20 may be curved,e.g., as shown in FIGS. 3 and 5.

Inner tube subassembly 25 is shown in greater detail in FIGS. 2, 3, 6,7, 7A and 8. Inner tube subassembly 25 generally comprises an inner tube71 and a bellows 72.

Inner tube 71 comprises a distal end 75, a proximal end 80, and a lumen83 extending from distal end 75 to proximal end 80. In one preferredform of the present invention, inner tube 71 preferably comprises adistal end surface 84.

Inner tube 71 comprises an opening 85 (FIG. 6A) comprising a distal edge90, a proximal edge 95, a first side edge 96 and a second side edge 97.

Inner tube 71 is rotatably disposed within outer tube 20 (FIGS. 2 and 3)such that rotation of inner tube 71 within outer tube 20 causes opening85 of inner tube 71 to repetitively sweep across window 50 of outer tube20, whereby to shear off tissue extending into window 50 of outer tube20 and opening 85 of inner tube 71. More particularly, as inner tube 71is rotated within outer tube 20, one or the other of first side edge 96and second side edge 97 of inner tube 71 is swept across one or theother of first side edge 65 and second side edge 70 of outer tube 20,depending on the direction of rotation of inner tube 71 relative toouter tube 20, so as to create a shearing action at the interface of theoverlapping side edges of inner tube 71 and outer tube 20. This shearingaction serves to cut away tissue extending into window 50 of outer tube20 and opening 85 of inner tube 71.

In accordance with the present invention, in order to allow inner tube71 to be rotated within a curved outer tube 20, and also to transmittorque along its length so as to enable the aforementioned cuttingaction, inner tube 71 preferably also comprises a plurality of slits 100(FIGS. 7 and 7A) which extend through the side wall of inner tube 71.Slits 100 are provided in at least the region of inner tube 71 whichflexes during rotation of inner tube 71 within curved outer tube 20.

Also in accordance with the present invention, novel powered shaver 5 isable to provide, independently or simultaneously, irrigation and/orsuction to the surgical site. In one preferred form of the invention,irrigation is supplied to the surgical site through the gap 73 betweenthe interior of outer tube 20 and the exterior of inner tube 71, andsuction is applied to the surgical site through the interior of innertube 71 (i.e., through lumen 83). Alternatively, suction may be suppliedto the surgical site through gap 73 (i.e., the gap between the interiorof outer tube 20 and the exterior of inner tube 71), and irrigation maybe applied to the surgical site through the interior of inner tube 71(i.e., through lumen 83).

In order to prevent slits 100 in inner tube 71 from creating a “shortcircuit” between the irrigation and suction lines, thereby underminingthe irrigation and suction functions, inner tube subsassembly 25comprises bellows 72 for effectively covering slits 100, whereby toisolate the interior of inner tube 71 from the region exterior to innertube 71.

More particularly, and looking now at FIGS. 2, 3, 6, 7 and 8, in oneform of the invention, bellows 72 comprises an elongated structurehaving a distal end 105, a proximal end 110 and a lumen 115 extendingtherebetween. Bellows 72 is mounted coaxially over inner tube 71, andits distal end 105 and proximal end 110 sealingly secured to inner tube71, so that slits 100 in inner tube 71 are covered by bellows 72. As aresult, bellows 72 sealingly isolates lumen 83 of inner tube 71 fromlumen 45 of outer tube 20. At the same time, bellows 72 do not interferewith rotation of inner tube 71 within outer tube 20. Bellows 72 aresized to cover at least the portion of inner tube 71 which comprisesslits 100.

Thus, where gap 73 (i.e., the gap between the interior of outer tube 20and the exterior of inner tube 71) is used for one of irrigation andsuction, and/or where the interior of inner tube 71 (i.e., lumen 83) isused for the other of irrigation and suction, bellows 72 prevent slits100 in inner tube 71 from creating a “short circuit” between theirrigation and suction lines. At the same time, inasmuch as bellows 72do not interfere with rotation of inner tube 71 within outer tube 20,bellows 72 do not undermine the cutting action of novel powered shaver5.

In one preferred form of the invention, bellows 72 comprise a pluralityof peaks 120 and troughs 125, wherein peaks 120 and troughs 125 extendperpendicular to the axis of bellows 72 (FIG. 6). Preferably peaks 120are sized to contact (e.g., with a sliding fit) the interior surface ofouter tube 20. Note that the contact between peaks 120 and the interiorsurface of outer tube 20 may be sealing, substantially sealing ornon-sealing. Alternatively, if desired, peaks 120 of bellows 72 canapproach but be spaced from the interior of outer tube 20.

In one preferred form of the invention, peaks 120 preferably includenotches 130 (FIG. 8) for allowing fluid to easily pass between theexterior of bellows 72 and the interior of outer tube 20, as willhereinafter be discussed. Note that notches 130 may be providedregardless of whether peaks 120 contact the interior surface of outertube 20.

As shown in FIG. 1, blade assembly 10 is intended to be mated to handleassembly 15 (or another handle assembly) at the time of use, anddetached from handle assembly 15 (or another handle assembly) after use(e.g., for cleaning and sterilization, repair or replacement, etc.).Alternatively, blade assembly 10 may be mated to handle assembly 15 (oranother handle assembly) at the time of manufacture, e.g., such as inthe case of a one-piece disposable system.

Handle assembly 15 is provided with a housing 135 for securely mountingthe distal end 40 of outer tube 20, and means for coupling a drive shaft140 to inner tube 71, e.g., a connector 145 which is secured to innertube 71, whereby to drivingly rotate inner tube 71 (and its associatedbellows 72, not shown in FIG. 1). Preferably connector 145 is providedwith appropriate ports so that the interior of inner tube 71 is in fluidcommunication with a port 150, whereby to deliver irrigation or suctionfrom an irrigation or suction source 151 to blade assembly 10 via lumen83 of inner tube 71. In one preferred form of the invention, port 150provides suction to blade assembly 10 via lumen 83 of inner tube 71.

Handle assembly 15 is also provided with a port 155 for accessing thegap between the interior of outer tube 20 and the exterior of inner tubesubassembly 25, whereby to deliver irrigation or suction from anirrigation or suction source 156 to blade assembly 10 via the gap 73between the interior of outer tube 20 and the exterior of inner tubesubassembly 25. In one preferred form of the invention, port 155 isconnected to irrigation source 156 so as to provide irrigation to bladeassembly 10 via the gap 73 between the interior of outer tube 20 and theexterior of inner tube subassembly 25. As noted above, in one preferredform of the invention, bellows 72 comprises notches 130 to allow fluidto pass easily between the exterior of bellows 72 and the interior ofouter tube 20.

It should be appreciated that handle assembly 15 shown in FIG. 1 isprovided by way of example but not limitation, and other handleassemblies may be used in conjunction with blade assembly 10.

In FIGS. 7 and 7A, slits 100 of inner tube 71 are shown as following ahelical path. However, if desired, other slit configurations may beutilized. By way of example but not limitation, slits 100 may extendsubstantially perpendicular to the longitudinal axis of inner tube 71.Thus, for example, FIG. 8A shows slits 100 extending substantiallyperpendicular to the longitudinal axis of inner tube 71, with the slitsbeing circumferentially staggered from one another. FIG. 8B shows slits100 extending substantially perpendicular to the longitudinal axis ofinner tube 71, with the slits being circumferentially aligned with oneanother. Still other configurations will be apparent to those skilled inthe art in view of the present disclosure.

In another preferred form of the invention, and looking now at FIGS. 9and 10, peaks 120 and troughs 125 of bellows 72 follow a helical pathabout the axis of bellows 72. In this form of the invention, notches 130may be omitted, inasmuch as fluid may pass between the exterior ofbellows 72 and the interior of outer tube 20 by following the helicalpath of troughs 125 of bellows 72.

It should be appreciated that, by forming a helical path along thelength of bellows 72 between peaks 120 and troughs 125, bellows 72 mayalso act as a screw pump, i.e., as a mechanical transport. Moreparticularly, rotation of inner tube 71 (and hence, rotation of bellows72) in a first direction facilitates distal movement of material (solidor fluid) disposed in the helical path. Rotation of inner tube 71 (andhence, rotation of bellows 72) in a second, opposite directionfacilitates proximal movement of material (solid or fluid) disposed inthe helical path. Note that this movement of material (solid or fluid)in either direction is independent of (or in addition to) any irrigationor suction which may be provided to gap 73 by irrigation or suctionsource 156.

The novel powered shaver 5 of the present invention is a significantimprovement in the art, since it is able to provide, eitherindependently or simultaneously, irrigation, cutting and/or suction in asingle device, where that device may have a curved (i.e., non-linear)configuration.

The novel powered shaver 5 of the present invention also provides adevice having a curved (i.e., non-linear) configuration, wherein thedevice comprises an outer tube and an inner tube rotatably disposedwithin the outer tube, with the lumen of the inner tube beingfluidically sealed from the gap between the exterior of the inner tubeand the interior of the outer tube.

Modifications of the Preferred Embodiments

It should be understood that many additional changes in the details,materials, steps and arrangements of parts, which have been hereindescribed and illustrated in order to explain the nature of the presentinvention, may be made by those skilled in the art while still remainingwithin the principles and scope of the invention.

What is claimed is:
 1. A cutting instrument comprising: an outer tubecomprising a distal end and a proximal end; an inner tube rotatablydisposed within said outer tube, said inner tube comprising a distalend, a proximal end and a region intermediate said distal end and saidproximal end, said region comprising a plurality of slits formed in saidinner tube so as to render said region of said inner tube flexible; anda bellows disposed adjacent to said plurality of slits so as to rendersaid region of said inner tube fluid-tight.
 2. A cutting instrumentaccording to claim 1 wherein said bellows is disposed about the exteriorof said inner tube.
 3. A cutting instrument according to claim 1 whereinsaid bellows comprises a distal end and a proximal end, and furtherwherein said bellows is secured to said inner tube at said distal end ofsaid bellows and said proximal end of said bellows.
 4. A cuttinginstrument according to claim 1 wherein said bellows is disposedexterior to said inner tube and interior to said outer tube, and furtherwherein the outer surface of said bellows is spaced from said outer tubeso as to provide a passageway between said bellows and said outer tube.5. A cutting instrument according to claim 1 wherein said bellows isdisposed exterior to said inner tube and interior to said outer tube,and further wherein the outer surface of said bellows contacts saidouter tube.
 6. A cutting instrument according to claim 1 wherein saidouter surface of said bellows is relieved so as to provide a passagewaybetween said bellows and said outer tube.
 7. A cutting instrumentaccording to claim 1 wherein said bellows is disposed exterior to saidinner tube and interior to said outer tube, and further wherein thebellows comprises a helical bellows so as to provide a helicalpassageway between said bellows and said outer tube.
 8. A cuttinginstrument according to claim 1 further comprising a suction sourceconnected to said proximal end of said inner tube.
 9. A cuttinginstrument according to claim 8 further comprising an irrigation sourceconnected to said proximal end of said outer tube.
 10. A cuttinginstrument according to claim 1 wherein said outer tube is curved.
 11. Acutting instrument according to claim 1 wherein said outer tube isflexible.
 12. A cutting instrument according to claim 1 wherein saidouter tube comprises a window having a window edge, said inner tubecomprises an opening having an opening edge, and said opening of saidinner tube is longitudinally aligned with said window of said outertube; and further wherein, when said inner tube rotates relative to saidouter tube, (i) during a first phase of rotation of said inner tuberelative to said outer tube, said opening is rotationally aligned withsaid window so as to allow an object to extend into said inner tube, and(ii) during a second phase of rotation of said inner tube relative tosaid outer tube, said opening edge passes by said window edge so as tocut an object extending into said inner tube.
 13. A method for cuttingan object, said method comprising: providing a cutting instrumentcomprising: an outer tube comprising a distal end and a proximal end; aninner tube rotatably disposed within said outer tube, said inner tubecomprising a distal end, a proximal end and a region intermediate saiddistal end and said proximal end, said region comprising a plurality ofslits formed in said inner tube so as to render said region of saidinner tube flexible; and a bellows disposed adjacent to said pluralityof slits so as to render said region of said inner tube fluid-tight; androtating said inner tube relative to said outer tube in order to cut theobject.
 14. A method according to claim 13 further comprising a suctionsource connected to said proximal end of said inner tube.
 15. A methodaccording to claim 14 further comprising an irrigation source connectedto said proximal end of said outer tube.
 16. A method according to claim13 wherein at least one of said outer tube and said inner tube comprisesa cutting surface.
 17. A method according to claim 13 wherein said outertube comprises a window having a window edge, said inner tube comprisesan opening having an opening edge, and said opening of said inner tubeis longitudinally aligned with said window of said outer tube; andfurther wherein, when said inner tube rotates relative to said outertube, (i) during a first phase of rotation of said inner tube relativeto said outer tube, said opening is rotationally aligned with saidwindow so as to allow an object to extend into said inner tube, and (ii)during a second phase of rotation of said inner tube relative to saidouter tube, said opening edge passes by said window edge so as to cut anobject extending into said inner tube.